Forensic Medicine
http://hdl.handle.net/2263/2655
2024-03-28T17:05:37ZFull-metal jacket mild steel core ammunition : a case report
http://hdl.handle.net/2263/93989
Full-metal jacket mild steel core ammunition : a case report
Blumenthal, Ryan; Rossouw, Servaas Hofmeyr
The deceased was a 26-year-old man who was killed in a multiple shooting incident while sitting alone in his car.
This individual was shot by multiple individuals, with different types of ammunition, from different angles. It is beyond the scope of this article to describe all the gunshot wounds. It is the intention of the authors to merely focus on the pathology of trauma of full-metal jacket ammunition with a penetrator (mild steel core in this presentation). The authors describe what was found at autopsy.
2023-12-01T00:00:00ZThe added value of molecular-based diagnostics in the African forensic medical setting
http://hdl.handle.net/2263/93101
The added value of molecular-based diagnostics in the African forensic medical setting
Van Deventer, B.S.; Makhoba, Aubrey Musa; Du Toit-Prinsloo, L.; Van Niekerk, Chantal
Sudden unexpected infant death (SUDI) is reported to be
an extraordinarily high burden in sub-Saharan Africa, with
the incidence rate in South Africa among the highest in the
world. It is common for the cause of many such infant deaths
to remain unexplained even after a full medico-legal death
investigation, and then to be categorised as a sudden unexplained
infant death (SUID). Fortunately, advances in molecular-
based diagnostics allow researchers to identify numerous
underlying inherited cardiac arrhythmogenic disorders in
many SUDI cases, with a predominance of variants identified
in the SCN5A gene. Such cardiac arrhythmogenic-related
sudden deaths generally present with no structural alterations
of the heart that are macroscopically identifiable at autopsy,
therefore highlighting the importance of post mortem genetic
testing. We report on a significant genetic finding that was
made on a SUDI case in which the cause was ascribed to an
acute bacterial pneumonia but it was still subjected to post
mortem genetic testing of the SCN5A gene. The literature
shows that many SUDI cases diagnosed with inherited cardiac
arrhythmogenic disorders have demonstrated a viral prodrome
within days of their death. It is therefore not uncommon for
these cardiac disorders in infants to be mistaken for flu, viral
upper respiratory tract infection or pneumonia, and without
the incorporation of post mortem genetic testing, any other
contributory causes of these deaths are often disregarded.
This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.
2022-09-01T00:00:00ZDevelopment of a cardiac channel molecular autopsy in a South African cohort of sudden unexplained deaths in the young
http://hdl.handle.net/2263/91631
Development of a cardiac channel molecular autopsy in a South African cohort of sudden unexplained deaths in the young
Sudden cardiac death is deemed a major global public health concern. In sub-Saharan Africa, including South Africa, there is a lack of reliable statistics on the incidence of SCD, even though a fourfold increase in noncommunicable diseases, largely due to cardiovascular diseases, has been reported. Considering that sudden cardiac deaths contribute to an estimated 50% of all cardiovascular deaths, it highlights South Africa’s need for research into better detection, treatment and prevention of sudden cardiac deaths. The aim of this study was to identify an inherited cardiac arrhythmogenic disorder, caused by variants in cardiomyopathy and arrhythmia-related genes, as a possible contributing factor to the cause of sudden cardiac deaths.
Next generation sequencing identified a total of 178 different missense variants among the entire study population (n = 66);164 were known, documented variants whereas the remaining 14 were novel. A total of 127 variants were of like benign significance, 33 were variants of unknown significance, whereas the remaining six variants were of likely pathogenic significance.
Post mortem genetic testing provided evidence of a genetic arrhythmic/cardiac conduction disorder as the probable pathogenic basis for 9% of sudden unexpected death / sudden unexplained infant death cases. Targeted next generation sequencing of 16 prevalent genes are recommended for routine testing in all unexplained sudden unexpected death / sudden unexpected infant death cases in South Africa.
Thesis (PhD (Medical Criminalistics))--University of Pretoria, 2023.
2023-01-01T00:00:00ZData collection and management in medico-legal death investigation in South Africa : an exploratory study
http://hdl.handle.net/2263/91393
Data collection and management in medico-legal death investigation in South Africa : an exploratory study
Mortality data are a cornerstone of public health initiatives and interventions and has been used to implement preventative strategies to reduce the burden of diseases and injuries in society. A subset of mortality data is non-natural mortality data, which can be used to reduce the burden of violence and injuries in a country. However, the benefits of such data cannot be fully utilised if there are not appropriate data collection, management, and dissemination protocols in place.
South Africa is a country with a high level of violence and non-natural deaths; however, current sources of non-natural mortality data have received criticisms in scientific publication for not being accurate. Initiatives to address this problem, most notably the National Injury Mortality Surveillance System, have been undertaken since the 90’s, by making use of state mortuaries as a source of non-natural mortality data. While these initiatives were able to introduce a new era of epidemiological study in the country, they were not sustainable in the long-term. These initiatives collected and disseminated data from state mortuaries in South Africa, but they did not work to implement standardised data collection and management protocols or a database that could collect and store data from the various state mortuaries.
In the United States of America, Australia, and New Zealand data collection and dissemination databases have been implemented, the National Vital Statistics System in the United States of America, and the National Coronial Information System in Australia and New Zealand. These initiatives show that it is possible to successfully implement a data collection and dissemination system for non-natural mortality data in countries that have varying medico-legal death investigation systems in different jurisdictions, and therefore that it should be possible to implement such a system in a country like South Africa where there is only one medico-legal death investigation system.
The aim of this study was to establish what data elements are and should be collected as part of a medico-legal death investigation service in South Africa and how the data can be routinely and systematically captured and utilised to be of benefit to society. Specifically, this research focused on the current data elements as well as data flow, collection, and management at a single urban mortuary in South Africa.
The study endeavoured to identify the data elements that are and could be collected for medico-legal death investigation in South Africa, assess the current storage, archiving, and management of data in medico-legal death investigation, identify the legal and ethical considerations pertaining to medico-legal death investigation, and to identify technical software that can be used to capture and manage medico-legal death investigation data.
To determine this, a three-part study was undertaken, a scoping review of available literature relating to data collection, capture, and management in medico-legal death investigation, as well as any related fields such as informatics and public health, a retrospective descriptive analysis of data from a single urban mortuary in South Africa for a period from 2017 to 2019, generating a three-year profile of cases at a typical urban mortuary in South Africa, and a fieldwork component to outline the flow of data and identify the key elements and categories of data that are routinely collected for non-natural deaths in South Africa.
Findings from this research showed that there is significant benefit in routinely collecting and disseminating non-natural death data from state mortuaries in South Africa. It also found that data collection and management practices from fields outside of medico-legal death investigation, specifically public health, can be adapted to suit the needs of medico-legal death investigation data. Significant findings from the retrospective review include the increasing proportion of suicides for the three-year period, as well as accidental deaths being the most common manner of death, road traffic fatalities being the most common external cause of death, and homicide numbers overtaking accidental deaths for the months of October to December. The fieldwork component of the study contextualised the current flow of data in medico-legal death investigation in South Africa and identified common data elements that are collected. This research found that commonly collected data elements for medico-legal death investigation are important for the generation of statistics related to non-natural deaths, but the lack of a routinised systematised data collection and management platform impacts the quality of data.
Overall, the results of this research suggest that the implementation of routinised and systematised data collection practices within the field of medico-legal death investigation would benefit the quality of non-natural mortality data in South Africa, however, what data elements and who owns the data needs to be agreed on before implementation can go forward. While this study utilised a single urban mortuary as a pilot for the exploratory study, it is suggested that further study into the current data practices in other mortuaries be conducted, to identify problems and opportunities that may be unique to different areas. It also is recommended that further in-depth study is undertaken into the observations that the retrospective analysis found, and that accurate and relevant denominators for specific areas be utilised so that future studies can be used as epidemiologic information.
Dissertation (MSc (Medical Criminalistics))--University of Pretoria, 2023.
2023-01-01T00:00:00Z